[目的]探讨他莫昔芬联合二甲双胍对多囊卵巢综合征(PCOS)合并不孕症患者脂代谢和预后的影响.[方法]选择2014年1月至2016年6月在本院诊治的PCOS合并不孕症的患者108例,按照随机数法分为观察组和对照组,每组54例.对照组患者采用他莫昔芬治疗,观察组患者在对照组基础上加用二甲双胍治疗.所有患者在月经期后d5开始给药,连续治疗21d为一个周期,在患者下次月经后d5再次治疗,共治疗3个周期,并于第四次月经期d5进行促排卵治疗,d10进行卵泡临床监测.对患者的临床效果进行评估,比较两组患者治疗前后黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E2)、催乳素(PRL)及睾酮(T)等性激素水平和总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(apo A)及载脂蛋白B(apo B)等脂代谢指标;对所有患者随访1年,对比两组患者的排卵、妊娠情况.[结果]观察组患者治疗后的总有效率显著高于对照组,差异具有统计学意义(P＜0.05);两组患者治疗后LH、E2及T的水平均明显降低,且观察组患者降低更明显,差异均具有统计学意义(P＜0.05);两组患者治疗后,TC、TG、HDL-C、LDL-C、apo A及apo B水平均明显升高,且观察组患者的TG及HDL-C水平显著高于对照组患者,LDL-C及apo B水平均显著低于对照组患者,差异均具有统计学意义(P＜0.05);经过随访发现,观察组患者治疗后正常排卵率及妊娠率均显著高于对照组患者,差异均具有统计学意义(P＜0.05).[结论]他莫昔芬联合二甲双胍能有效改善PCOS合并不孕症患者的临床症状,调节患者机体内性激素水平和脂代谢平衡,促进患者正常排卵,提高患者排卵率和妊娠率,值得临床推广.“,”[Objective]To investigate the effect of tamoxifen and metformin on lipid metabolism and prognosis in women with polycystic ovary syndrome(PCOS)complicated with infertility.[Methods]A total of 108 cases of PCOS complicated with infertility were selected from January 2014 to June 2016 in our hospital.According to the random number method,patients were divided into the study group(54 cases)and the control group(54 cases).Patients in the control group received tamoxifen and patients in the study group were treated with tamoxifen and metformin.All patients started administration at d5 after menstrual period,and 21 days of continuous treatment was a cycle.The patient received the same procedure again at d5 of the next menstruation,and a total of 3 cycles were given.At the fourth menstrual period d5,ovulation induction therapy was used and follicular clinical monito-ring was performed at d10.To evaluate the clinical effect of patients,luteinizing hormone(LH),follicle stimula-ting hormone(FSH),estradiol(E2),prolactin(PRL),and testosterone(T)were detected before and after treat-ment in the two groups.Meanwhile lipid metabolism indicators like total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A(apo A)and apolipoprotein B(apo B)were also detected.All patients were followed for one year,and the ovula-tion and pregnancy status of the two groups were compared.[Results]The total effective rate of patients in the study group after treatment was significantly higher than that in the control group,the difference was statistically significant(P ＜0.05).After treatment,the levels of LH,E2,and T in the two groups of patients decreased sig-nificantly,and the study group had a more significant decrease,with a statistically significant difference(P ＜0.05).While the levels of TC,TG,HDL-C,LDL-C,apo A and apo B were significantly increased in the two groups after treatment.TG and HDL-C levels were significantly higher than those in the control group,while the LDL-C and apo B levels were significantly lower than those in the control group ;the differences were statistically signifi-cant(P ＜0.05).After follow-up,the normal ovulation rate and pregnancy rate in the study group were signifi-cantly higher than those in the control group,the differences were statistically significant(P ＜0.05).[Conclu-sion]Tamoxifen combined with metformin can effectively improve the clinical symptoms of polycystic ovary syn-drome with infertility patients,regulate the body＇s sex hormone levels and balance of lipid metabolism,promote normal ovulation to increase the ovulation rate and pregnancy rate of patients.It is worthy of clinical promotion.